News Release
April 2019 | University College London, Gower Street, London – Dementia more preventable in Asia and Latin America

Close to one in two cases of dementia could be preventable in low- to middle-income countries, finds a new UCL study.

Dancing in Peru
The findings, published in The Lancet Global Health, found how improving childhood education and other health outcomes throughout life could reduce the risk of dementia.

“After our previous research finding that one in three cases of dementia could be preventable, we realised that the evidence was skewed towards higher-income countries,” said the study’s lead author, Dr Naaheed Mukadam (UCL Psychiatry).

“We have now found that in low- to middle-income countries in Asia and Latin America, dementia may be even more preventable than it is in more wealthy countries. If life-course risk factors such as low levels of education in early life and hearing loss, obesity and low physical activity in mid-life to old age are addressed, these countries could see large improvements in their dementia rates.”

While the number of people with dementia is increasing globally, particularly in low- to middle-income countries, there have been modest reductions in age-specific dementia rates in many high-income countries over the last two decades.* The researchers say this could be due to improvements in health outcomes throughout life that affect dementia risk.

The research team built on their previous work for the Lancet Commission on dementia prevention, intervention, and care, published in 2017, which found that 35% of dementia is attributable to nine risk factors: low levels of childhood education, hearing loss, smoking, hypertension, obesity, physical inactivity, social isolation, depression, and diabetes.*

To understand whether the commission’s findings would apply equally to global regions that were underrepresented in the report, a team of UCL researchers sought out data from China, India and Latin America. They drew from the research collective 10/66 Dementia Research Group’s data, which used similar methodology to gauge prevalence of the nine risk factors in those countries, with sample sizes of 1,000 to 3,000 in each country.

The researchers found even more potential for preventing dementia across the globe, as the proportion of dementia linked to the nine modifiable risk factors was 40% in China, 41% in India and 56% in Latin America.

A major factor in that difference is the lower levels of educational attainment in low- to middle-income countries, which the researchers say signals hope for the future, as education levels rise.

“People growing up in Asia and Latin America today are more likely to have completed schooling than their parents and grandparents were, meaning they should be less at risk of dementia later in life than people who are already over 65. Continuing to improve access to education could reap great benefits for dementia rates in years to come,” Dr Mukadam said.

On the other hand, social isolation is a major risk factor of dementia in higher income countries, but much less so in China and Latin America. The researchers say that public health officials in countries such as the UK could learn from China and Latin America in efforts to build more connected communities to buffer against the dementia risk tied to social isolation.

Obesity and hearing loss in mid-life, and physical activity in later life, were also strongly linked to dementia risk in the study area, as well as mid-life hypertension in China and Latin America and smoking in later-life in India.

“Reducing the prevalence of all of these risk factors clearly has numerous health benefits, so here we’ve identified an added incentive to support public health interventions that could also reduce dementia rates. The growing global health burden of dementia is an urgent priority, so anything that could reduce dementia risk could have immense social and economic benefit,” Dr Mukadam said.

Senior author Professor Gill Livingston (UCL Psychiatry) added: “A lot of the findings of health and medical research derive primarily from higher income countries such as in Western Europe and North America, so ensuring that research is inclusive is vital to the development of global public health strategies.”

“While we don’t expect these risk factors to be eliminated entirely, even modest improvements could have immense impact on dementia rates. Delaying the onset of dementia by just five years would halve its prevalence*,” she said.

The researchers are supported by the National Institute for Health Research UCLH Biomedical Research Centre, Wellcome, NIHR, Economic and Social Research Council, and NIHR Collaboration for Leadership in Applied Health Research and Care North Thames.

Dementia is a cruel disease that robs people of their memory, their judgement and their identity. Unfortunately, there is no cure, and in the past few years a number of clinical trials for new dementia drugs have failed – the latest being Biogen’s drug aducanumab. Without any effective treatments on the horizon, most people’s best hope is to avoid getting dementia in the first place.

One of the hallmarks of dementia is cognitive decline. There are several lifestyle changes that may slow cognitive decline, such as doing mentally stimulating activities (crossword puzzles, learning a new language), getting plenty of exercise and maintaining a healthy diet – especially one low in saturated fats, refined carbohydrates and sugar.

Of these, diet is a favourite among health reporters, perhaps because the message can be delivered clearly and succinctly. The latest such story comes from the Daily Mirror which claims that eating just two teaspoons of nuts a day “boosts brain function by 60%”. If the claim is true, we should all be rushing out to buy a bag of nuts, but is this what the study actually says?

The article is based on an observational study published in the Journal of Nutrition Health and Aging. After assessing the diets of nearly 5,000 adults in China (aged 55 and older) over a period of nine years, the researchers found an inverse relationship between the amount of nuts people ate and the degree of cognitive decline they experienced. Those who consumed more than 10g of nuts and seeds a day were less likely to show a fall in their cognitive function compared with those who consumed less than 10g a day.

Out of the 4,822 participants in the study, 67% had their cognitive ability tested twice (only 16% were tested more than twice over the course of the study). Where more than one cognitive measurement was made, cognitive performance decreased over time, but people who ate more than 10g of nuts per day decreased the likelihood of this decline. Consequently, the results suggest that consuming two teaspoons of nuts per day may preserve cognitive performance and may lead to better cognitive ageing over a lifetime. The results do not show that eating nuts improves cognitive function, as the Mirror headline claimed.

Limitations

Participants in the study inevitably varied on a number of factors, including education, general health, nutritional intake and lifestyle factors, such as exercise. Although the way the data was analysed took those factors into account and still found an association, cognitive decline and dementia are strongly influenced by many environmental and genetic factors, and it is unlikely that consumption of one particular food is sufficient to ward off dementia.

Another weakness of this study is the fact that participants reported their nut consumption via a questionnaire. Evidence shows that self-reported food consumption should always be interpreted with caution.

Although randomised controlled trials indicate that eating nuts has an effect on blood flow (including to the brain), there isn’t enough evidence to draw conclusions about their impact on cognitive function.

What we can say at this point is that the evidence on nuts and cognitive decline is promising, but it isn’t strong enough to make nutritional recommendations. Simply consuming two teaspoons of nuts per day is unlikely to reduce your risk of dementia.

Press Release
February 2018 | Aarhus University – Being surrounded by green space in childhood may improve mental health of adults by Peter Bondo

Being surrounded by green space in childhood may improve mental health of adults

Children who grow up with greener surroundings have up to 55% less risk of developing various mental disorders later in life. This is shown by a new study from Aarhus University, emphasizing the need for designing green and healthy cities for the future.

A new study from Aarhus University shows that children who grow up surrounded by high amounts of green space have up to 55% less risk of developing a mental disorder later in life. According to the researchers, integration of green space in urban planning is important to ensure green and healthy cities for the future generations. Model photo: Colourbox.dk.

A larger and larger share of the world’s population now lives in cities and WHO estimates that more than 450 millions of the global human population suffer from a mental disorder. A number that is expected to increase.

Now, based on satellite data from 1985 to 2013, researchers from Aarhus University have mapped the presence of green space around the childhood homes of almost one million Danes and compared this data with the risk of developing one of 16 different mental disorders later in life.

The study, which is published today in the prestigious American Journal PNAS, shows that children surrounded by the high amounts of green space in childhood have up to a 55% lower risk of developing a mental disorder – even after adjusting for other known risk factors such as socio-economic status, urbanization, and the family history of mental disorders.

The entire childhood must be green

Postdoc Kristine Engemann from Department of Bioscience and the National Centre for Register-based Research at Aarhus University, who spearheaded the study, says: “Our data is unique. We have had the opportunity to use a massive amount of data from Danish registers of, among other things, residential location and disease diagnoses and compare it with satellite images revealing the extent of green space surrounding each individual when growing up.”

Researchers know that, for example, noise, air pollution, infections and poor socio-economic conditions increase the risk of developing a mental disorder. Conversely, other studies have shown that more green space in the local area creates greater social cohesion and increases people’s physical activity level and that it can improve children’s cognitive development. These are all factors that may have an impact on people’s mental health.

“With our dataset, we show that the risk of developing a mental disorder decreases incrementally the longer you have been surrounded by green space from birth and up to the age of 10. Green space throughout childhood is therefore extremely important,” Kristine Engemann explains.

Green and healthy cities

As the researchers adjusted for other known risk factors of developing a mental disorder, they see their findings as a robust indication of a close relationship between green space, urban life, and mental disorders.

Kristine Engemann says: “There is increasing evidence that the natural environment plays a larger role for mental health than previously thought. Our study is important in giving us a better understanding of its importance across the broader population.”

This knowledge has important implications for sustainable urban planning. Not least because a larger and larger proportion of the world’s population lives in cities.

“The coupling between mental health and access to green space in your local area is something that should be considered even more in urban planning to ensure greener and healthier cities and improve mental health of urban residents in the future,” adds co-author Professor Jens-Christian Svenning from the Department of Bioscience, Aarhus University.

If you engage in cognitively stimulating activities in midlife, such as reading and playing games, you can reduce dementia risk by about 26 per cent, according to research.(Unsplash/Rawpixel), CC BY-SA

This number is growing: around 50 million people live with dementia today, and this number will rise to over 130 million worldwide by 2030.

You do not have to wait until you are 65 to take action. In the absence of treatment, we must think of ways to protect our brain health earlier. This month is Alzheimer’s Awareness month — what better time to learn how to reduce your risk of dementia, whatever your age?

There are three dementia risk factors that you can’t do anything about: age, sex and genetics. But a growing body of evidence is discovering early-life, mid-life and late-life contributors to dementia risk that we can do something about — either for our own or our children’s future brain health.

Before going any further, let’s clear up some common confusion between Alzheimer’s disease and dementia. Dementia is a term to describe the declines in cognitive abilities like memory, attention, language and problem-solving that are severe enough to affect a person’s everyday functioning. Dementia can be caused by a large range of diseases, but the most common is Alzheimer’s.

A diet high in unrefined grains, fruit, vegetables, legumes, olive oil and fish has been linked to lower dementia rates.(Unsplash/Ja ma), CC BY

Poorer nutritional opportunities that often accompany low socioeconomic position can result in cardiovascular and metabolic conditions such as hypertension, high cholesterol and diabetes that are additional risk factors for dementia.

And low education reduces the opportunities to engage in a lifetime of intellectually stimulating occupations and leisure activities throughout life that build richer, more resilient neural networks.

Aerobic activity not only helps us to maintain a healthy weight and keep our blood pressure down, it also promotes the growth of new neurons, particularly in the hippocampus, the area of the brain most responsible for forming new memories.

(Unsplash/Bruce Mars)

Stay social and eat well in later years

While the influences of socioeconomic position and engagement in cognitive and physical activity remain important dementia risk factors in late life, loneliness and a lack of social support emerge as late life dementia risk factors.

You have heard that you are what you eat, right? It turns out that what we eat is important as a dementia risk factor too. Eating unrefined grains, fruit, vegetables, legumes, olive oil and fish, with low meat consumption — that is, a Mediterranean-style diet — has been linked to lower dementia rates.

Leading an engaged, healthy lifestyle is thought to increase “cognitive reserve” leading to greater brain resiliency such that people can maintain cognitive functioning in later life, despite the potential accumulation of Alzheimer’s pathology.

Thus, although all of these factors may not stop Alzheimer’s disease, they can allow people to live longer in good cognitive health. In my mind, that alone is worth a resolution to lead a healthier, more engaged lifestyle.

My Brain Robbie, a fantastic new initiative to promote brain health among school going children, has been launched through the Pilot Awards for Global Brain Health Leaders, an initiative of the Global Brain Health Institute (GBHI), Alzheimer’s Association and Alzheimer’s Society UK. The project includes an animated video of a little brain which helps children learn about the eight steps to keeping our brains healthy, along with free educational resources for parents and teachers.

The My Brain Robbie campaign aims to fill an educational gap in the field of dementia prevention by generating a public health educational initiative for children aged 6 to 12 years. It also aims to increase global public awareness of the importance of brain health across the lifespan, rather than it being considered that brain protection strategies are an issue only for the elderly.

The video and materials bring together the latest scientific research in neurology and epidemiology which encourage early prevention and lifelong healthy lifestyles to mitigate the risk of developing chronic brain diseases including Alzheimer’s disease. Recent studies project that up to 30% of dementia may be preventable by targeting modifiable risk factors. The initiative was developed by researcher, doctor/physician and Atlantic Fellow for Equity in Brain Health at GBHI, Dr. Eleonore Bayen.

‘Learn’ touches on the role of education, cognitive stimulation and learning new things, in building cognitive reserve.

‘Be active’ describes the importance of physical activity and preventing sedentary lifestyles. Bad habits can develop as a result of spending too much time in front of electronic screens, a key issue for children, not to mention adults too!

‘Avoid head injuries’ looks at the prevention of traumatic brain injury.

‘Have a healthy diet’ refers to the “Mediterranean diet”. Another Atlantic Fellow, Claire McEvoy, among others has demonstrated the benefits of the ‘Mediterranean diet’ for brain health.

‘Avoid dangerous substances’ educates children in age-appropriate language about the dangers of tobacco and drug intake as well as excessive alcohol use.

‘Sleep well’ explains the importance of healthy sleep.

‘Take good care of your health’ looks at the importance of following medical care instructions for chronic diseases that can impact brain health, for example, hypertension.

‘Spend time with family and friends’ highlights the importance of social interaction for keeping our brains healthy.

My Brain Robbie, which was funded by GBHI and the Alzheimer’s Association, empowers children to maintain a healthy brain throughout their lives by providing them with simple public health messages. Dr Bayen hopes that, by providing information about brain health as part of early life education, this will create a shift in perceptions, beliefs, attitudes and stigma towards diseases of the brain, particularly dementia, in this generation and beyond.

Dr Bayen said: “This pilot arrives at a perfect time in history when the fight against dementia in high, low and middle income countries has become a top priority with an urgent need for innovative actions and “out of the box” thinking in prevention and care. While education at school offers us an amazing opportunity to fight stigma as well as social and health inequities, it appears that ‘dementia prevention and brain health at school’ is currently not being addressed and this would surely improve public awareness worldwide.”

She continued: “We hope that by teaching these important healthy brain habits to a younger generation that this may, in turn, educate upwards through the generations by motivating their parents and grandparents to learn more about the subject of brain health and dementia prevention. It may also, in turn, help to create a more supportive and inclusive living environment for people with neurocognitive disability and to create a feeling of optimism in a field of neurology where there have been limited therapeutic successes. Children are often wonderful teachers for their peers, parents, grandparents, and society at large.”

Dr Bayen worked in collaboration with a wide variety of experts such as neuroscientists, medical and health professionals, education specialists, teachers, parents, communication and design experts, as well as other Atlantic Fellows and faculty from GBHI.

The videos are currently available in English and French with plans to translate these into many more languages. My Brain Robbie welcomes interest from educators, health groups, parenting communities and others in sharing this initiative with as many children as possible.

She was inspired to develop the initiative during her Atlantic Fellowship with GBHI based at the University of California, San Francisco and Trinity College Dublin. GBHI focuses on protecting the world’s aging populations from threats to brain health. Collectively with partners, GBHI aims to reduce the scale and impact of dementia. The Pilot Awards for Global Brain Health Leaders is an initiative launched by GBHI and partners, the Alzheimer’s Association and the Alzheimer’s Society UK. The awards aim to support emerging leaders in brain health protection by funding small-scale innovative activities to delay, prevent, or mitigate the impact of dementia.

“Dr Bayen’s work is a wonderful example of GBHI’s approach to attaining a global impact on dementia prevention. It engages inter-professional contributions to development on a global scale. It also recognizes that brain protection is a life-long dialogue. Her innovative strategy of teaching children who will then engage in dialogue within households to ‘educate-up’ to parents and grandparents while reducing the stigma of dementia is timely.” said Victor Valcour, Executive Director of GBHI and the Atlantic Fellows for Equity in Brain Health program.

Dr Bayen said: “As a researcher and also a physician, I feel that my duty is not only to advance pure science but also to communicate it with others in creative ways. I hope that the My Brain Robbie campaign inspires children to feel responsible for their own brain health and to become aware of others’ brain health too.”

Dr Eleonore Bayen holds a Medical Degree with specialty training in Neurology and a PhD in Health Economics. She specializes in traumatic brain injury (TBI). She has advanced experience in architecting educational intervention programs about brain and disability for patients, family caregivers, and non-medical populations. Dr. Bayen was supported in her Atlantic Fellowship as a Fulbright grantee to the United States and was trained at the University of California, San Francisco site of GBHI in 2016. In this capacity, she was selected to be part of the first international class of the Atlantic Fellows who graduated from the Global Brain Health Institute in 2017. Bayen is currently an assistant professor in neuro-rehabilitation in Paris at Sorbonne University – La Pitié-Salpêtrière hospital.

Unlike the effervescent bubbles that stream to the top of champagne flutes on New Year’s Eve, what I call brain bubbles are far from celebratory. These bubbles are metaphorical rather than physical, and they distort the stream of reality processed by our brains. Like a real estate bubble that reflects an inflated perception of home values, a brain bubble twists your perception of the world around you. And when either of these bubbles bursts, the results can be devastating.

Problems arise when distorted information results in flawed decisions that negatively affect our lives. As a neuroscientist who’s worked closely with laboratory rats for over three decades, I’ve gleaned from them a few good strategies people can use to burst brain bubbles and enhance well-being in the year ahead. Rat brains are small but have the same general areas and neurochemicals we have, so these rodents are valuable laboratory models for human behavior.

Getting back down to Earth

Psychoactive drug use, aspects of privilege and poverty, psychiatric illness and, in some cases, religious and political beliefs can all create brain bubbles. Even daily excursions to the virtual world of apps, social media and cybergames sever our connections to concrete aspects of the real world and let distorting brain bubbles develop.

This is especially problematic for children’s brains that are still developing. An ongoing National Institutes of Health study suggests that two hours of screen time each day distorts language and thinking abilities in these junior digital users.

As our attention is hijacked by the closest screen while a Roomba cleans the floor and Alexa orders pizza to be delivered to the front door, what’s left for our brains to do? Sure, we likely face cognitive challenges at work each day, but human brains are built for sophisticated and complex activity – even though we’re often lulled into mindlessly scrolling through a virtual feed. In fact, a brain area often associated with reward and pleasure, the nucleus accumbens, is smaller in people who spend more time checking Facebook posts on their smartphones.

Obviously, some of these distortion-generating circumstances are out of our control. But a heightened awareness of our authentic world can move us toward a more reality-based, well-grounded brain – free of those brain bubbles.

The rats that my students and I train in our studies to physically work for coveted treats (Froot Loops cereal is a favorite) develop healthier emotional responses than the animals we call “trust-fund rats” because they’re merely given their sweet rewards. The harder-working rats have healthier stress hormone levels and engage in more sophisticated search strategies when they encounter a surprise challenge – such as when we move their expected Froot Loop rewards. They’re more persistent as they spend time trying to solve the problem, rather than quickly giving up and walking away.

So whereas one popular New Year’s resolution involves saving up to build financial capital, we can keep our brains in peak condition for the year ahead by building up experiential capital. Real-world experiences represent the best currency for our brain circuits, providing neural security for our future decisions in the coming year. Spending time engaged in hobbiessuch as knitting or gardening, for example, with complex movements and rich sensory experiences, provides a valuable yield for our brains.

Savor the anticipation

When the calendar flips to a new year, it’s common to reflect on the past and look to the future. According to the neuroscience literature, this anticipation could be one of the most pleasurable – and healthy – tasks our brains engage in all year long.

Dopamine is the poster neurotransmitter for the cognitive endeavor of anticipating. Traditionally known for its role in pleasure, this neurochemical system can be hijacked by psychoactive drugs such as cocaine that serve as potent creators of reality-distorting brain bubbles.

Rodent research provides fascinating insights here, however. Researchers use sophisticated techniques to measure dopamine activity as rats press laboratory levers that reward them with drugs. Surprisingly, this neurochemical system surges when the animal merely anticipates taking the drug as it approaches the drug lever, as well as when the drug is actually infused into the brain.

Anticipating a new start and a new year may be a scaled-down version of approaching the experimental lever for a hit of cocaine – a legal and healthy dopamine dose in this case. You can try to keep this emotional high going through the year by amping up the anticipation in your daily life: Focus more on delayed than immediate gratification. Buying and planning for experiences is more satisfying than material purchases. Mapping out a menu, shopping for ingredients and cooking a meal provides more dopamine time – and brain-engaging behaviors – than nuking a frozen meal and eating it three minutes later.

Rats in the lab suggest active minds are better able to overcome stress and surprise adversity.Kelly Lambert, CC BY-ND

Seize the reins of your stress

Another way to enhance our well-being through the year is to gain some sense of control over the stress in our lives. Real-time and authentic interactions with the environment can help us gain a sense of control over the inevitable uncertainty and unpredictability we face each day.

I see evidence of this in the lab. When I furnish my rats’ housing with natural elements such as dirt, hollowed-out logs and rocks, they’re busier and less likely to sit around the edge of the cage than animals in boring empty cages. After building their experiential capital, these enriched rats have healthier stress and resilience hormone profiles and engage in bolder behaviors, such as diving to the bottom of swim tanks instead of staying on the top doing their best impression of a dog paddle. As I watch these animals in various tasks, they appear to be gaining control over the challenges they encounter.

Perhaps this is why retired U.S. four-star admiral William McRaven emphasized simple life strategies in his 2014 University of Texas commencement speech, declaring that “if you want to change your life and maybe the world, start off by making your bed.” Then, even if you have a terrible day, you will come home to a made bed, evidence that you had a positive impact in at least one area of your life that day.

Starting your brain’s year off right

Lessons from the laboratory rats also provide potential explanations for some of my own personal favorite New Year’s Day traditions – including the mundane tasks of cooking a familiar southern meal, cleaning my closet and watching HGTV’s Dream House giveaway with my family while we all declare what we would do if we won the beautiful house. Move in? Sell it? Make it an Airbnb rental?

Thinking like a neuroscientist, I know that cooking and cleaning are active endeavors with clear outcomes that allow me to gain a small sense of control, decreasing stress hormones. Playfully anticipating winning a new home taps into that feel-good dopamine system as we contemplate more serious options for the new year. And, perhaps the best neurochemical hit of all is the spike in oxytocin, the neurochemical involved in positive social connections, as I spend time with loved ones.

Although it’s common to turn to pharmaceuticals to lift our emotions and improve our mental health, the emotional benefits of many New Year’s traditions remind me that basic responses can serve as what I call “behaviorceuticals” that enhance well-being. New Year’s resolutions may take the form of New Year’s Rx’s as we consider healthy lifestyle choices for the coming year: Shrink those distorting brain bubbles and build realistic connections to enrich life’s simple pleasures.

Humans have big brains and our frontal lobes, just behind the forehead, are particularly huge. Injuries to this part of the brain often happen after blows to the head or a stroke. Paradoxically, some people with frontal lobe injuries can seem unaffected – until they’ve been carefully evaluated.

The frontal lobes are sometimes described as the executives of the brain, or conductors of the orchestra. Among other things, they control and organise our thinking and decision-making processes. You rely on your frontal lobes when you do things like make plans, switch from one activity to another, or resist temptation.

Some people with frontal lobe injuries seem completely normal in short one-to-one conversations, but they actually have great difficulty with everyday tasks, such as cooking, organising their paperwork or remembering to take medication. This is called the frontal lobe paradox because, even though these people seem unimpaired when assessed, they have significant difficulties in everyday life.

Without specialist expertise in acquired brain injuries, it can be almost impossible to spot frontal lobe paradox because, in many cases, people will still be able to speak normally and seem remarkably unimpaired. They may be unaware of their difficulties and deny that they need any help or support.

Insight issues

People affected by the condition are not lying when they say they don’t need help or support. Instead, they may lack knowledge of their own condition because areas of the frontal lobes that are responsible for self-monitoring and developing insight have been affected by their brain damage.

A second reason for the frontal lobe paradox is that the skills needed for an assessment interview are different from those needed in everyday life. The structure and routine of an environment, such as a rehabilitation ward, can, in effect, play the role of someone’s frontal lobes. This can mask the difficulties people experience in less structured, open-ended environments. For this reason, a person’s level of ability needs to be assessed in a situation that resembles everyday life. A seemingly simple task, such as going shopping, can reveal difficulties in people who appear unimpaired on standard tests of memory and attention, and have normal intelligence.

Lack of specialist training

Neuroscientists and doctors have known about the frontal lobe paradox for at least 50 years, but it is not always understood by non-specialists. This situation can lead to people not receiving help they desperately need.

For example, in England and Wales, social workers and care managers are usually responsible for deciding whether a person has the capacity (under the Mental Capacity Act 2005) to decline support or care. These are hardworking professionals who are motivated to act in the best interests of those under their care, but many receive little or no specialist training in brain injury.

These professionals tend to base their decision about a person’s mental capacity on a short face-to-face interview. This is exactly the situation that can lead to people with frontal lobe damage being denied the care that they need.

The assessment provides the support needed for a person to sound competent and able, but only for the duration of the assessment. In one example, a woman persuaded a series of professionals that she could safely live alone after a significant brain injury. In reality, she could not make meals for herself or remember to take her lifesaving medication. Sadly, she died at home shortly afterwards.

Support needed

We don’t know exactly how common the condition is, but the frontal lobe paradox is probably found in a much higher number of people than you might first imagine. As well as those who have suffered blows to the head and strokes, it can affect people with certain infections, some forms of dementia and even poorly controlled diabetes.

It is vital that social workers and care managers are trained on brain injury to protect the interests of people with frontal lobe injuries. People with these injuries are in particular need of support, but they are often the least likely to receive it.